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Diffusion-Weighted Imaging, Apparent Diffusion Coefficients, and Fluid-Attenuated Inversion Recovery MR Imaging in Endophthalmitis

Zoran Rumboldta, Christopher Mosesa, Ursula Wieczerzynskia and Ranjiv Sainia

a From the Department of Radiology, Medical University of South Carolina, Charleston, SC



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  		FIG 1. Imaging of a 52-year-old woman with endophthalmitis, before intravitreal and systemic antibiotic therapy.

A, Axial contrast-enhanced CT image shows marked periscleral thickening and enhancement on the right. The right vitreous body is of slightly increased attenuation.

B, Axial T2-weighted image at a similar level shows periscleral hyperintensity surrounding the right globe. There is no difference in signal intensity or appearance between the 2 vitreous bodies.

C, Corresponding axial contrast-enhanced T1-weighted image reveals enhancement on the right, both periscleral and along the entire uveal tract. There is no evidence of enhancement within the vitreous body.

D, Corresponding axial FLAIR image shows hyperintense uveal tract that is contiguous with a nodular lesion in the anterior aspect of the right globe. The rest of the right vitreous body appears hypointense compared with the contralateral globe. The periscleral abnormality is less conspicuous.

E, Axial DWI at a similar level demonstrates marked hyperintensity within the right orbit, especially in the anterior and medial aspect of the globe.

F, Corresponding axial ADC map shows that the diffusion is indeed decreased within the right globe, with signal intensity comparable to and lower than the brain parenchyma. The mean ADC value in the anterior and medial aspect measured 573 x 10-6 mm2/s, and in the central portion 2808 x 10-6 mm2/s. The left globe is hyperintense, similar to the intracranial CSF, with mean ADC value of 2813 x 10-6 mm2/s.



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  		FIG 2. Images in a 52-year-old woman with endophthalmitis, 5 days after intravitreal and systemic antibiotic therapy was initiated.

A, Axial precontrast T1-weighted image shows relative hyperintensity of the right vitreous body and periscleral tissue that is isointense with the brain. The findings are comparable to Fig 1A.

B, Axial T2-weighted image at the same level again shows periscleral hyperintensity surrounding the right globe. The right vitreous body and the uveal tract are now of subtle heterogenous appearance with a relative decrease in signal intensity.

C, Corresponding axial contrast-enhanced T1-weighted image again shows uveal tract and perisclearal enhancement on the right.

D, Corresponding axial FLAIR image reveals diffuse heterogenous appearance and relative hyperintensity of the right vitreous body. Periscleral tissue of similar signal intensity is also seen.

E, Axial DWI at a similar level demonstrates some relative hyperintensity of the right globe, far less prominent compared with the pretreatment image, Fig 1E.

F, Corresponding axial ADC map shows hypointensity consistent with decreased diffusion in the periphery of the right globe, which is now slightly higher than in the brain parenchyma. This area is of increased signal intensity in comparison with the pretreatment image, whereas the central portion is of slightly lower signal intensity, which is not conspicuous. The mean ADC value in the anterior and medial aspect measured 927 x 10-6 mm2/s, and in the central portion 2336 x 10-6 mm2/s. The mean ADC value in the left globe was 2813 x 10-6 mm2/s.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X